
STIS, STDS: WHAT SHOULD I KNOW ABOUT THEM?
September 25, 2024
WHY USE HIV PREVENTION?
September 29, 2024I recently started a HIV TikTok account to educate the youth in South Africa about HIV and HIV prevention. To my surprise, I found that there is a massive gap in HIV knowledge on social media. I assume it’s because the prevalence of HIV isn’t as great in other parts of the world as it is in Southern Africa, and there aren’t many American Influencers doing trending HIV dance videos.
Not only are we limited by the general knowledge gap, but there are also many accounts spreading false information about HIV, to gain high view counts. Example: “She got HIV because her neighbor cursed her.”
I kid you not.
Of course, that one video got a couple of thousand views.
In essence, there are a lot of informative videos out there. We just have to make sure we consume the right ones.
I’ve worked in HIV medicine for over 5 years, and I have a post graduate diploma in HIV management. I am also a certified HIV training mentor, i.e. I train the nursing staff to manage patients with HIV, so that they are able to initiate HIV treatment and HIV prevention. In this post I will be providing a bit of basic HIV information which I teach the nursing staff when starting my training course.
What is HIV?
HIV stands for Human Immunodeficiency Virus.
It is a viral infection, which causes your body’s immune system to weaken.
This happens because the HIV particles slowly kill some of your immune cells, also known as CD4 cells. As your CD4 cells die, the HIV virus gets stronger, and they produce more HIV particles, which then in turn, kills off more CD4 cells. This is how HIV continuously causes immune decline. It is an ongoing process which is only stopped by taking ARVs.
How is HIV spread?
The most common means of transmission is by having unprotected sexual intercourse with an infected individual. There are other means of transmission, such as: mother to child transmission, IV drug users that use the same needles, or occupational exposure: splashes/ needle stick injuries. HIV is not transmitted by kissing, hugging, or sharing food with a HIV positive person. Certain people are more at risk of getting infected with HIV: sex workers, people who regularly have unprotected intercourse, having multiple sexual partners or having intercourse under the influence of alcohol/drugs. These increase your chances of getting infected due to increasing the amount of exposure. Having a STI increases your risk of bleeding in the genital area, and therefore also increases your risk of getting HIV. MSM (males who have sexual relations with other males) also are at an increased risk of getting HIV. All people at risk are eligible to get HIV prevention (PrEP).
What are CD4 counts, and what are Viral Loads?
CD4 counts are the amount of “soldier” cells in the blood.
They are one group of the immune cells which help your body fight off infections. The normal CD4 count should be 500-1000+. In HIV, you may have a low, or sometimes normal CD4 count. This differs between individuals.
Generally, if you have HIV and have a CD4 count of >200, you often do not need any extra protection other than ARVs.
If your CD4 count is < 200, you would require another medication – in addition to ARVS – in order to assist your immune system to fight off infection.
Viral Loads (VL) are the amount of HIV particles found in the blood.
On diagnosing someone with HIV, we do not check the viral load, because it is expected that the VL would be in the millions. So instead, we start ARVs, and check the Viral Load 3-4 months after starting ARVs. This is when the viral load is helpful. It allows us to determine whether you are taking the treatment correctly; or in the rare event, you are resistant the ARVs.
ARVs, what do I need to know?
ARVs, also known as anti-retro virals, is the only treatment available for HIV. It works by stopping HIV from killing the CD4 cells, and stopping the virus from making more viral particles. There are so many new studies happening to improve ARVs in South Africa. Currently, we have very efficient ARV drugs: the best one being Dolutegravir. It is fairly new. It only became available to the South African public in the year 2020.
The majority of patients are only taking one tablet a day.
The only people ineligible for this tablet are patients with kidney disease, age < 15yrs, weight <35kg, or if you’ve previously had resistant HIV.
The 1 tablet combination includes 3 ARV ingredients in each tablet.
It is to be taken daily, and at the same time every day.
You can generally work out which time is best suited for you. However, most patients choose to take it in the morning because many people have difficulty falling asleep after taking the tablet.
Which brings me to discuss the side effects of ARVs. 99% of my patients have little to no issues with the ARV tablets. Very few of them complain that their skin itches in the beginning, which often resolves after a few days. They may complain of struggling to fall asleep, as mentioned previously, but this is easily corrected by taking the tablet during the morning. A small percentage may also experience a slight increase in weight. Other than that, most people tolerate the ARVs very well.
There is a small percentage of patients who may develop a reaction to the ARVs. This can be dangerous. You may develop a skin reaction, a liver reaction, or rarely a kidney injury after starting the ARVs.
This is the reason for numerous appointments, and routine monitoring by all HIV health professionals, in the beginning stages of ARV intiation.
This is also why we are required to be doing regular blood checks, especially in the beginning of your treatment plan. When starting ARVs, it is important to return to the clinic if you have any of the following symptoms: a new rash, vomiting or diarrhea, as this may indicate that you could be having a reaction to the medication.
What is AIDS?
AIDS stands for Acquired Immuno-deficiency Syndrome. It is a term we don’t use anymore. It was previously used to describe severe or Stage 4 HIV. When patients CD4 count drops to below 200, they tend to get infected with illnesses that wouldn’t generally affect healthy individuals. These infections are called Opportunistic Infections. Some of these infections include: CMV viral infections, Shigella, Salmonella Diarrhea, Toxoplasmosis, Disseminated TB (Tuberculosis) and sometimes even cancers such as Lymphoma, and Kaposi Sarcoma. These conditions would categorize patients into stage 4 HIV. The ARVs that we have available today is so effective and well tolerated that these stage 4 illnesses are much less common than a few years ago. Most people living with HIV and are taking ARV treatment correctly are living full and healthy lives, with no limitations in their physical ability.
HIV Testing: If I test HIV negative, does this mean I don’t have HIV?
The answer is yes, and no. Most of the time testing negative means you do not have HIV. But there is a small percentage that you may be HIV positive, but still be in the window period.
The window period is the period in which the HIV has just entered your body.
The HIV virus is busy multiplying in your blood. It has not been around your body long enough for the body to create HIV antibodies. HIV antibodies are soldier cells that your body makes to fight HIV.
When your body “sees HIV” in the blood – your body then signals your immune system to create antibodies to HIV. It takes 3-6 months for the immune system produce HIV antibodies. The HIV antibody is what the HIV tests pick up. So, if your body hasn’t made antibodies yet, it will not be picked up in the test: and you will test negative. This is why it’s always important to retest for HIV after 6 weeks – 4 months.
The 2 most important parts of HIV management are: ARVs and patient education. I’ve noticed when I educate my patients about all the above, they have better insight into their condition. When they understand why ARVs are important, their adherence is a great deal better, and when their adherence is good, they live full, healthy and unaffected lives: free from TB and free from other infections.
– by Dr S Jakoet